Multiligament Injuries
Multi-ligament knee injuries refer to the damage of two or more ligaments in the knee, a complex joint that relies on several key structures to maintain stability and function. Ligaments are crucial for controlling the knee’s movements and ensuring proper alignment during various activities. A multi-ligament injury often involves the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL), but can also affect other structures critical to knee stability. These injuries are serious and can significantly impact mobility and long-term knee health.
The knee joint is stabilized by four main ligaments:
- Anterior cruciate ligament (ACL) – Located in the front of the knee, the ACL controls forward movement of the tibia (shinbone) and helps prevent hyperextension.
- Posterior cruciate ligament (PCL) – Found in the back of the knee, the PCL controls backward movement of the tibia and helps stabilize the knee during flexion.
- Medial collateral ligament (MCL) – Positioned on the inner side of the knee, the MCL resists valgus forces (inward bending) and prevents the knee from collapsing inward.
- Lateral collateral ligament (LCL) – Located on the outer side of the knee, the LCL resists varus forces (outward bending) and helps stabilize the knee against lateral movements.
Additionally, the knee has secondary structures like the posterior oblique ligament (POL), popliteus tendon, popliteofibular ligament, and oblique posterior ligament, which help control rotational forces and prevent abnormal knee motions. Damage to these ligaments often results in significant instability, pain, and limited mobility.
A knee dislocation is a severe form of multi-ligament injury involving the disruption of both cruciate ligaments (ACL and PCL). This injury is particularly dangerous because it leaves the knee highly unstable and can result in damage to surrounding blood vessels and nerves, including the popliteal artery, the primary blood supply to the lower leg. In extreme cases, knee dislocations can be life- or limb-threatening, making immediate medical attention crucial.
There are two primary types of knee dislocations:
- Sports-related dislocations – These typically occur during athletic activities that involve sudden twists, pivots, or direct impacts to the knee. Quick reduction (realignment of the bones) is critical to prevent further damage.
- High-energy dislocations – These result from high-velocity impacts, such as those from motor vehicle accidents or falls from significant heights. High-energy dislocations are more severe because they often involve damage to the skin, muscles, tendons, blood vessels, and nerves.
In both cases, prompt diagnosis and treatment are essential to minimize complications and improve the chances of a successful recovery.
Orthopedic surgeon Dr. Mark Cinque is a sports medicine surgeon in San Diego, California who specializes in the treatment of complex knee injuries. He has spent time training at The Steadman Clinic and Stanford Orthopaedic Surgery. He has published over 100 peer-reviewed manuscripts and has presented research internationally. He uses minimally invasive arthroscopic procedures to preserve the natural joint and reduce recovery time to accelerate his patients’ return to the activities they love.
At a Glance
Mark Cinque, MD
- Board-certified, fellowship-trained orthopedic surgeon
- Orthopedic Residency: Stanford University, Fellowship: The Steadman Clinic
- Authored over 100 peer-reviewed publications
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